Provider Demographics
NPI:1477032159
Name:DELEON, ELYSE (BCBA)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:DELEON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5795
Mailing Address - Country:US
Mailing Address - Phone:903-431-9283
Mailing Address - Fax:
Practice Address - Street 1:4460 FARM TO MARKET 1626
Practice Address - Street 2:SUITE 300
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5823
Practice Address - Country:US
Practice Address - Phone:512-354-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-21-54435103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-18-51981OtherBACB